Advantages of integrative acupuncture (there are several names for contemporary scientific acupuncture - biomedical acupuncture, western medical acupuncture, intramuscular stimulation etc. What's important is not the name but that this approach is inherently self-questioning, open to new evidence and largely theory neutral)
- IA is easily explained to other healthcare providers and clients in a contemporary modern context.
- IA treatment is easily integrated into treatment protocols of other healthcare providers so that patients and other providers can more readily integrate their treatments with those of the acupuncturist.
- IA is readily adaptable to modern anatomical and physiological disease descriptions. The same holds for the holistic orientation of wellness and preventive medicine. Again this enables all providers to be on the same page and patients benefit from improved coordination of services.
- IA can be tested and evolved in the current evidence-based medicine climate. This means patients can benefit from clinical improvements as new research is done.
- IA has no quasi-religious overtones and therefore can be accepted by anyone no matter what their belief system may be.
- IA is simple, effective and enables a clearer prognosis of treatment outcomes. This means patients are less likely to get vague answers about treatment outcomes and direction.
- IA naturally promotes greater transparency in the therapeutic relationship than is possible in traditional pre-scientific medicines whose terms, language and diagnostic proceedures are often confusing to patients and difficult or impossible to translate.
- IA doesn’t claim to treat everything (as is often implied in traditional acupuncture) and so is more realistic in its approach to health conditions.
Real and sham acupuncture points both work?
In recent years an increasing number of high quality studies have been done confirming the efficacy of acupuncture and establishing it as a low impact therapy suitable for the modern clinical environment. However despite outcomes often being at least comparable or better than standard therapies for such conditions as arthritis and back pain the trials frequently show only a small difference between acupoints based on traditional Chinese medicine theory and those selected at random yet usually in the body area where the treated symptoms occur.
www.medpagetoday.com
The similarity in effectiveness between classical “meridian” acupoints and non-traditional acupoint areas has also been clearly shown in fMRI studies of brain changes during real-time acupuncture, (Ma, Ma, Cho). Though here again carefully selected acupoints usually show somewhat more widespread calming of pain associated brain regions. In addition it has been suggested that light or minimal acupuncture may stimulate specific nerve fibers which then transmit signals to the parts of the brain that reduce the unpleasantness of pain without changing its intensity. Whereas the classic stronger sensation from twisting the acupuncture needle actually reduces the intensity of pain.
www.acupunctureinmedicine.org.uk
Though the acupuncture effect can be induced by needling wide areas of the body surface, far more extensive than traditional meridian acupoints, there is nevertheless a definite trend in these studies that favors some kind of careful acupoint selection for optimal effectiveness. This may be due to what clinical experience has shown; that a brief, moderately strong needle stimulus often ensures a faster and firmer clinical outcome. Such a stimulus is more likely to occur in specially chosen areas such as tender areas, trigger points and areas of a high concentration of nerves below the skin such as muscle motor points and junctions between muscles and tendons. Many of these areas are the locations of major classical acupoints.
This does not however provide support for the elaborate theory and methodology of traditional acupuncture as rather than highly specific effects these acupoints seem to induce a non-specific, widespread stimulus toward healing mediated by the brain. These and other discoveries are paving the way for new simpler neurological and anatomical styles of acupuncture.
www.biomedacupuncture.com
Although integrative acupuncture has its roots in traditional acupuncture and Chinese medicine it represents a major step forward and departure based on the scientific evidence so far as well as a clear-eyed look at clinical practice. This involves a simplification in the practice of acupuncture yet in many respects greater anatomical precision in diagnosis and placement of needles. It also means that treatment protocols and the positive outcomes of acupuncture can be described in contemporary medical language.
Given that modern scientific research demonstrates widespread self-healing effects in the body mediated through the brain and neuroendocrine structures with acupuncture needling, the holistic nature of traditional acupuncture, which is so attractive to many healthcare consumers and practitioners alike, is retained in a greatly simplified treatment process.
Thus a new and interesting treatment is brought into modern biomedicine without violating biomedicine’s highly successful anatomical and physiological basis.
Meridians or blood vessels?
Traditionally acupuncture was thought to stimulate the dynamics of blood flow, which ancient doctors felt on pulses throughout the body. The assumption was that for example if the pulses were weak then this indicated that various vital influences unseen in the body were weakened. Acupuncture was seen to assist in promoting healing. These vital influences are likely the physiological processes well understood now and stimulated by acupuncture’s neurovascular and immunological effects understood through scientific investigation today.
There is no direct archeological evidence of acupuncture being used before around 200 BCE. Prior to this period bloodletting was probably the piercing therapy used (along with the use of heat with moxabustion). Acupuncture may well have arisen from this practice which as a medical art did not always involve excessive bleeding but the use of fairly precise locations and would likely have produced a similar neuromuscular effect.
Many acupuncturists today will still explain the acupuncture effect as balancing the flow of “Qi” (usually referred to as “energy”) in the meridians. However the term Qi is generally thought to be untranslatable and there are literally dozens of types of Qi in the main traditional Chinese medicine texts.
Also as pointed out above the channels (meridians) of Chinese medicine where probably a shorthand codification of the vascular system as understood through the filter of a pre-modern cosmology. It is not hard to see that the pulsing of blood and warmth or coolness of the extremities could be interpreted to represent internal conditions of vitality, weaknesses or over-heated conditions such as inflammation or fever within the body.
http://www.pacificcollege.edu/pcom_static/alumni/newsletters/summer2001/energy_meridian.htmlThe current popular yet mistaken notion that energy moves around in 14 “meridian” pathways traversing the body can in part be traced to mistranslations made by westerners in the early 20th century as well as redaction or the projection of Western notions back into traditional Chinese medical literature.
While there is rapidly increasing evidence that the nervous system responds in surprisingly subtle ways to acupuncture needling there is no credible evidence for these “meridians” despite over 40 years of research around the world. (See Links page.)
Hence leaving behind most of the traditional theory which as has been shown elsewhere tends to be dogmatically rigid and somewhat confused (see Links page) and moving forward with a modern scientific approach (integrative acupuncture) is interestingly more in sync with the down to earth observations of the ancient Chinese doctors.
Additional comments
The activity of an acupuncture point/area is deactivated when the sensory nerve to that point is severed or blocked. This suggests the primacy of neural signaling over and above as yet unknown factors.
There are dozens of different systems of acupuncture (over 80 in China alone) These may include different meridians, acupoints almost anywhere on the body, microcosms of the body almost anywhere e.g. hands, feet, ears, nose, abdomen and scalp. In these areas there are often entirely different representations of the body used by different proponents of microsystems (miniature body maps) in that same body area. As time goes by the microsystems are often reconfigured by their proponents putting the representative acupoints in an entirely different place than where they were previously supposed to have worked.
The diversity of acupuncture systems is likely mostly explained by the physiological fact that acupuncture is largely non-specific in its effects. That is it stimulates the whole body via the brain toward improved health and functioning and in the process provides specific symptom/condition relief.
Most of the central effects of acupuncture needling now have strong biomedical evidence and at least testable theories for their mechanisms. So the need to defend acupuncture against those who claim it is “just” a placebo is greatly lessened.
The need now and in the near future is increased proof of efficacy for specific health conditions in differing individuals and groups. There is always room for improvement in the directions of greater simplicity and better efficacy.
“This complexity [of Chinese Medicine] is in stark contrast to the simplistic and often naive historical accounts found in modern Western secondary literature on acupuncture and Oriental medicine.”
“No reliable history of acupuncture is available in Western languages or Chinese.”
“It is a fact that more than 95 percent of all literature published in Western languages on Chinese medicine reflect Western expectations rather than Chinese historical reality.”
Paul Unschuld, historian of Chinese Medicine
“The more we understood the mechanism [ of acupuncture ] the clearer it became: it should be a biomedically-sound way to practice acupuncture, without constrictions of the existing rigid meridian system and without antiquated procedures."
Yun Tao Ma Ph.D, LAc, Neuroscientist and Acupuncturist
“The traditional "Channel/Meridian" theory simply reflects the level of medical knowledge of the ancient doctors, who tentatively tried to explain the interrelatedness between the parts of the body surface and the internal organs
Over several centuries, clinical realities that did not fit into an existing theory of Chinese Medicine were often suppressed to ensure continuity of the theories, in a style that the Chinese call "cutting the foot to fit the shoe".
The "Channel/Meridian" theory has successfully accomplished its historical mission of preserving and developing acupuncture, though presently in the form of 14 rigid lines it has become the narrow neck of the bottle which is impeding further development of acupuncture medicine in the 21st century.”
Prof. Huang Long-xiang, Vice President of Acupuncture Institute of China Academy of Chinese Medical Sciences in Beijing and Editor-in-Chief of Acupuncture Research and World Journal of Acupuncture. Quoted by Yun Tao Ma
"... it is important to recall that as the official manual of Acupuncture and Moxibustion, published by the Chinese Academy of Sciences (CAS) explicitly states, the theoretical tenets of traditional acupuncture are ‘naïve’ theories with ‘definite limitations’ that have played an active role in the development of natural sciences in China [1]. They reflect the laws of nature to some extent and can serve as an analogy to explain some of the physiological functions of human organs, but ‘owing to limitations inherent in the historical development of ancient Chinese society, the theories are incomplete and need to be perfected through continuous research and summation in clinical practice’ [1]. Given this candid admission, in an era when genome–based pharmacology and therapeutic cloning appear to be not–too–distant possibilities, licensing primary healthcare providers in America based upon pre–scientific premises such as yin, yang and qi, not only is epistemologically unjustifiable, it is also unethical. There is now enough clinical evidence indicating that acupuncture might be effective for certain, but not all, conditions [40]. This efficacy could be linked to the recently discovery that the physical stimulation of the nervous system can provide direct means to modulate the innate immunity and the ‘inflammatory reflex’ [41,42]. Based on this body of scientific evidence, it is now time for health agencies that regulate the practice of acupuncture in the US to disentangle themselves from the promotion of Eastern metaphysics and religious philosophy, and instead assume their public duty of enforcing the teaching and the implementation of the essential elements of standard healthcare. "
From Traditional Acupuncture and the Resurrection of Vitalism, by Ben Kavoussi, MS
